Should we discuss the costs of care for sick pets with our clients?

In a discussion I moderated at the recent Western Veterinary Conference (WVC), the following questions were posed to an audience of 150 colleagues:

1) Do financial constraints limit your ability to provide the quality of care you would like for your patients?

YES = 94% NO = 6%

2) If yes, is this a source of frustration for you?

YES = 91% NO = 6%

Overwhelming conclusion: Houston, we have a problem.

3) Do you routinely discuss vaccination protocols and the need for neutering with all your clients?

YES = 94% NO = 6%

We take the time to discuss medical procedures that prevent life-threatening illness in the individual pet (vaccines), and that contribute towards curbing pet overpopulation (neuter). Excellent.

4 ) Would enhanced financial coverage reduce the frequency of "economic euthanasias"?

YES = 75% NO = 25%

Conclusion: Our clients would benefit from either financial assistance, or the knowledge of the costs of care for a major medical illness.

5) Do you routinely discuss the costs of emergency or specialist care for pets with your clients?

YES = 25% NO = 75%

6) Do you routinely discuss pet health insurance with your clients?

YES = 15% NO = 85%

The problem

If these responses are at all representative, there are some real inconsistencies here that we need to consider. How do we reconcile that financial limitations are a significant burden to our patients, that these constraints sometimes mean the difference between the life and death of the animal (as well as affecting our own sense of career satisfaction), yet we seem unwilling to take the time to forewarn or inform our clients in advance of the rising costs of veterinary medical care or provide them information about insurance coverage. As specialists invest in laparoscopy, CT and MRI equipment, do you think these costs are diminishing?

As professionals devoted to the improvement of pet health, it is our collective moral responsibility to do our best to ensure that pet owners can defray the costs of ever-improving levels of medical care.

I know what some of you are thinking: "Most of my clients don't see a specialist for the lifetime of the pet, so what's the big deal here?" In fact this was a comment I received at WVC. I would venture to guess that a majority of your patients receive emergency care during their lifetime, and the concept clearly applies here.

Over my 15 years associated with 24-hour centers, I know that when an old dog with gastric-dilation/volvulus (GDV) comes in at 3 a.m., you can bet that a discussion of the value of the money spent out of pocket versus anticipated future years of the dog will ensue, as the owner decides if it's "worth" saving the dog's life.

In addition , I've heard colleagues justify their inaction by claiming that "since my clients don't complain about my bills, this isn't an issue I need to handle ".The present burden of financial constraints on client's decisions at specialty/emergency centers sometimes results in the general practitioner blaming the referral center either for fees that are too high, or for being financially inflexible or inconsiderate of their clients' emotional needs.

In fact, the shoe can be placed on the other foot; that is to say, if clients were better prepared by their family doctor, the costs at 24-hour facilities may not come as such a shock. Clearly, we all deserve to be well compensated for our work, and we all would like to practice in a world in which pet care could be provided without sensitive discussions regarding cost.

I would venture to say I've seen far more animals die as a result of their owners' inability (unwillingness?) to afford our recommended care, than due to fleas, prostatic disease, pyometra and breast cancer combined. Yet, we seem to have no problem spending our valuable time during puppy/kittenhood discussing the value of flea control and neutering.

Why do we ignore this problem?

My suspicions for why we ignore this problem include:

• Many of us haven't thought about it.

• We don't like discussing money with our clients.

• This topic may not be perceived as a warm and fuzzy bonding experience when we are trying to foster a relationship with the pet owner.

• We are not motivated that it's our problem.

• We don't see direct economic value to client education as we do with neuter/vaccines.

• We fear a candid discussion of the costs of medical care may alienate the client, or detract from your image as a caring doctor.

I've got news for you...re-read the answers to questions 1 and 2 above. This is our problem, and it's not going to get better by ignoring it.

Professional excuses

After the session at WVC, numerous colleagues made the following comments regarding this controversial contention:

• "I didn't go to vet school to sell insurance." In my opinion, we sell medical services every day to our clients. Hopefully, we do so by our conviction of what is truly best for their pet. Yes, you "sell" neuters, vaccines, flea products and medical services. You do so because you believe in the value of these services.

• "You don't see pediatricians warning mothers to start saving money for their baby's imminent ear infections." That's true; pediatricians don't have to worry about this, because far more of their clients (parents) have insurance coverage for their children, than our clients do for their pets. Yet, we don't give our clients the benefit of knowing that insurance even exists!

• "I don't have the time to discuss this with my clients." Make the time, and divert flea control and neutering discussions to your staff.

• "If I take the time to discuss this, my clients won't listen, and they won't change their behavior." Based on this premise, your physician should not concern him/herself with your obesity, smoking, work hours, stress and other lifestyle issues having a detrimental effect on your health. After all, he/she's not a counselor, right?

• "I do tell my clients at the time of referral to be prepared to spend a few thousand dollars."

From my viewpoint, this is like telling someone it's going to hurt after you've ripped off the Elastikon bandage from his hairy skin. Your clients need to start saving for that PU surgery, ACL tear, or splenic tumor when the pet is young.

The solution

I believe it's time for a new paradigm in which all general practitioners take greater responsibility for your clients' inabilities to cope with the ever-increasing costs of sick care for their pets.

No, you are not responsible for putting their money under a mattress or advising them on investments. Yes, many of them will ignore this valuable, and life-saving advice. So what? Many clients decline your annual dental prophies, yet I hope you don't stop offering them if you feel they are necessary.

Letting your clients know that insurance and credit plans exist, and that the cost of a major illness can run thousands of dollars, is your obligation as a responsible family doctor. Although my hospital carries credit and insurance brochures in the lobby, for most clients, the initial exposure to the veterinary medical system is through their visit to the general practitioner for vaccines.

Consider how your valuable time is spent with your patients in the first six months of their lives, and which subjects will have the greatest impact on their ultimate longevity and quality of life.

Besides the profound impact of behavioral/elimination problems leading to euthanasia decisions, I can't think of another matter that carries such a dramatic and daily impact on us, our patients and clients, that for now, we choose to ignore.

Until the day arrives when most of us take the time to discuss the costs of medical care with our clients, I will continue to feel saddened and responsible when the next pet owner in my exam room looks up at me through tears and states, "I had no idea it would ever cost this much to save my dog 's life".